for the post of
ADMINISTRATIVE, RETAIL AND HELP DESK OPERATIVE
CONFIDENTIAL STAFF APPLICATION FORM
THIS FORM SHOULD BE COMPLETED IN BLACK INK, OR MAY BE WORD PROCESSED
1. PERSONAL INFORMATION
Name in full Mr, Mrs, Miss, Ms Surname
Marital Status Date of Birth
Telephone No. __________________ (H) _______________________________(M)
E-mail address _____________________________________________________
2. SECONDARY EDUCATION
Senior Certificate/ 'A' Level
School Dates GCE ('O' Level), GCSE, RSA (including
Subjects and Grades Grades)
3. HIGHER / FURTHER EDUCATION
Name of Institution Dates Courses Followed Qualification(s)
4. ADDITIONAL QUALIFICATIONS (WITH GRADES)
5. A PRESENT EMPLOYMENT
Date of Name and Address of Employer Position Held and Present Salary
Brief Description of Duties.
Period of notice required.
B EMPLOYMENT HISTORY
Dates Name and Address of Employer Details of Position Held
6. RELEVANT ADDITIONAL INFORMATION
You may use this space to give further information in support of your application.
For example you may wish to highlight training, personal interests, or other
experience not previously mentioned which you feel may be relevant.
Please give the names, e-mail addresses, telephone numbers and status of two
referees who should be able to comment on your professional work. At least one
must be a previous employer and not related to you.
Prior consent of referees should be obtained.
8. DECLARATION BY APPLICANT
I HEREBY CERTIFY AND DECLARE THAT:
(a) I have read the information pertaining to the position for which I now make
application and that all the questions on this form have been accurately answered
to the best of my knowledge and belief.
(b) I am not suffering from any disability, which would prevent the satisfactory
discharge of the duties of the post for which I have applied.
Signature of Applicant Date
CLOSING DATE: 12 Noon, Monday 19 September 2011
Please return to:
The General Manager’s Secretary
This form must be returned along with the Fair Employment Monitoring questionnaire
on the next page
MONITORING QUESTIONNAIRE Private & Confidential
Ref No: AdminOp/2011/ Date of Birth:
We are an Equal Opportunities employer. We do not discriminate on grounds of religious belief or
political opinion. We practice equality of opportunity in employment and select the best person for
To demonstrate our commitment to equality of opportunity in employment we need to monitor the
community background of our employees, as required by the Fair Employment (NI) Order 1998.
Regardless of whether we practice religion, most of us in Northern Ireland are seen as either
Catholic or Protestant. We are therefore asking you to indicate your community background by
ticking the appropriate box below.
I am a member of the Protestant community
I am a member of the Roman Catholic community
I am a member of neither the Protestant nor
Roman Catholic community
Could you please indicate whether you are: Female Male
If you do not complete this questionnaire, we are encouraged to use the ‘residuary’
method which means that we can make a determination on the basis of personal information on
Note: It is a criminal offence under the legislation for a person to ‘give false information in
connection with the preparation of the monitoring return’.